Genetic Facial Lipo-atrophy

May 5, 2008

Hello Dr Pierone,

Appreciate your taking on this new forum!

One thing that I wanted to point out to your readers is that there is such a thing as "age-related" facial lipo-atrophy (facial wasting) that has a genetic link and can be a "normal" part of aging. My paternal line has a strong genetic propensity for facial wasting that hits at around age 50 and by age 60 pretty much does away with the bulk of fat in the face.

This is a mixed blessing for me, in that since it's "expected" it won't be one of the "signs" that outs me to my family, but I'm also anxious if my HIV and its treatment will have an "additive" effect, causing this behavior to show up sooner and/or cause the waisting to occur faster?

I got my diagnosis at age 39, and with treatment (and diet and exercise) over the last year I've managed a full recovery back into "normal" (albeit low normal) ranges. So is it more likely that my bad genetics will have the larger impact on facial lipo-atrophy for me, or am I doubly screwed? ;-)

THANKS!
-Zac

Response from Dr. Pierone

Hello and thanks for posting.

Not only is there an age-related facial wasting, there is simply genetic variation with some families in whom their members are destined to go through life with a thin face.

As an example I take care of a couple in which one partner has been on HAART for over 10 years and has had a good response to multiple Sculptra and Radiesse treatments for lipoatrophy. The other partner has never been on medications but looks like he has facial lipoatrophy based on a genetically thin facial structure. He told me that all of the men in his family have a gaunt appearance going back generations.

In your situation it is likely that antiretroviral treatment would be expected to have an additive effect layered over your genetic substrate. So when you start therapy it makes sense to use a cocktail with less risk of lipoatrophy.

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